IPHI CHW /CHW Supervisor Training Inquiry for Organizations

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* 1. Name

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* 2. Title

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* 3. Organization/Agency/Company

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* 4. Email Address

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* 5. Phone Number

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* 6. Please select the type of training(s) you are interested in. (Select all that apply.)

CHW Core Training (100 hours)

CHW Continuing Education

Site supervisor and/or care team training on CHW integration

CHW recruitment and/or screening

Other (please specify)

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* 7. When do you anticipate needing training?

Within 3 months

Within 6 months

Within a year

Other (please specify)

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* 8. Approximately how many CHWs would need training?

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* 9. Approximately how many CHW Supervisors would need training?

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* 10. Please provide a brief description of your particular training needs.

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* 11. Where would you be willing to travel to attend training? Please select all that apply.

District of Columbia

Maryland

Virginia

None of the Above

If you require training outside of the District of Columbia, Maryland, or Virginia, please contact:
Dwyan Monroe at dmonroe@institutephi.org.